Liverpool Care Pathway: Relatives 'must be informed'

Elderly man's hands There will be a 12-week consultation on the proposed changes to the NHS constitution

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Relatives of terminally-ill patients would have to be consulted before a decision to withdraw food or water is taken, under new government proposals.

It comes after some patients were placed on the Liverpool Care Pathway - designed to relieve suffering - without their relatives' knowledge.

The government wants to ensure families are told of life and death decisions.

The instruction will be included in a number of proposed changes to the NHS Constitution to be unveiled on Monday.

The Liverpool Care Pathway was developed at the Royal Liverpool University Hospital and the city's Marie Curie hospice to relieve suffering in dying patients, setting out principles for their treatment in their final days and hours.

Supporters say it can make the end of a patient's life as comfortable as possible and the method is also widely backed by doctors and many health charities.

However, critics argue it can be inhumane.

The government has now said that the rules needed to be stricter, meaning relatives of patients are always consulted before the technique is applied.

'New right'

A Department of Health (DoH) spokesman said the proposed changes would set out a "new right" under the NHS Constitution, which was established by the Health Act 2009, but he stopped short of describing the move as a "legal requirement".

However, the spokesman added: "Anybody providing NHS services is required by law to take account of it [the NHS constitution] in their decisions and actions."

Some reports suggested health trusts that failed to involve patients and families in decisions could be sued, while doctors could face being struck off.

The DoH spokesman said it was unlikely policy had been developed on this as the proposal was still at an early stage.

Health Secretary Jeremy Hunt will launch a 12-week consultation on the proposed changes to the constitution - the formal statement of patients' rights - on Monday.

Health minister Norman Lamb said this week that it was "completely wrong" for terminally-ill patients to be put on a "pathway" to death without relatives being consulted.

Mr Lamb has called a meeting of doctors and patients to discuss worries about the pathway.

Meanwhile, Conservative peer Baroness Knight called for an inquiry into claims some people might have survived had they not received this treatment.


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  • rate this

    Comment number 114.


    It's being incorrectly reported. Nowhere in the LCP is there anything about withholding food and drink from someone who wants it. People who a dying don't have an appetite, and thirst is reduced. Wetting their mouth with sponges, and a bit of subcutaneous fluid is usually administered; much kinder than ramming a nasogastric tube down them.

  • rate this

    Comment number 113.

    Relatives and patients know what is best for them. Medical staff implement science's latest best guess to what maybe correct.

  • rate this

    Comment number 112.

    Many people do not seem to understand the LCP. The implementation of the pathway arose from extensive evidence-based practice. It is also used in healthcare settings other than hospices so that patients unable to be in a hospice environment can still have a comfortable, dignified death. It seems that the media have distorted the use of the pathway and people have formed opinions based on this.

  • rate this

    Comment number 111.

    Withdrawing fluids is just plain spiteful. We have no way of knowing how much a terminally ill patient can feel. They may not be self-aware or conscious, but they have a nervous system that will continue to register the traumas of dehydration.
    Withdrawing intravenous feeding and medication make sense, but pain relief and fluids - NEVER. Had you seen someone die this way, you'd agree.

  • rate this

    Comment number 110.

    The LCP is a Care Pathway. It guides and informs. It does not replace clinical judgement nor is it prescriptive. In many care settings where knowledge of end of life care is lacking, it provides staff with a means of improving the quality of care they provide. Families have raised concerns over the past couple of weeks, and these have mainly been due to poor communication , NOT usage of the LCP.

  • rate this

    Comment number 109.

    My mothers life was ended, she stopped breathing after being given two injections.Her drip had been empty for two days. Before she died the nurse placed a black garment with purple satin lining at the foot and head of her bed. The LPC was never mentioned. It was Christmas Day.

  • rate this

    Comment number 108.

    Not everybody is lucky enough to have a sudden catastrophic event at the end. For most people death takes several days and is often distressing for both patients and relatives. The LCP allows professionals to alleviate symptoms of agitation, pain and breathlessness at the end of life and let a patient die with some dignity and peace. To suggest this is murder or inhumane is staggering.

  • rate this

    Comment number 107.

    We were consulted, we said no, gave written evidence that our mother agreed with our decision. They said okay for now yet they withdrew food and water..........10 days later my mother died.
    1. Consulting does not mean listening.
    2. In this world it seems that dying peacefully really means quietly. Weak people lose the ability to cry out.
    It eases the conscience of some to believe it peaceful

  • rate this

    Comment number 106.

    As somebody said earlier, medics do not know best...but they know a heck of a lot better and more than the non-medical relative. Though a mere dentist, my sole duty is to my patient and I am obliged to do what is best for THEM and not their relatives.

  • rate this

    Comment number 105.

    There is a special word in our culture for doing something that causes even the life of somebody who is already dieing to end early. To me the method of death described sounds like hell on earth. I cannot imagine anything worse than not being able to get something to drink. Of course if payement and incentives are used there will be those who will bend the rules as far as possible for max payment.

  • rate this

    Comment number 104.


    I don't think its daft, despite our flaws, accepting we are animals is not the same as saying we are *merely* animals. I've never heard of animals creating art - interesting.


    "...unless ...might as right."

    I don't think that. That humans are superior to animals is, in my opinion, self evident. We have a duty to animals they cannot reciprocate that.

  • rate this

    Comment number 103.

    The LCP aims to provide comfort and dignity during the final stages of life. It is unethical for doctors to deny this if family members (not patients themselves) are unable to accept how ill their loved one is or are not contactable. Good communication with family is essential but asking them to sign away their loved one before proper end of life care is given is a disservice to all concerned.

  • rate this

    Comment number 102.

    A few points: 1/ hunger/thirst may be minimal/absent at the end of life. 2/ the LCP makes it clear that relatives need to be involved. 3/ it is a management pathway, not a diagnostic pathway - it is important that reversible conditions have been considered, though it is not always appropriate to treat these. 4/ it is a pathway aimed at relieving distress, rather than one that causes death.

  • rate this

    Comment number 101.

    There is misunderstanding around hospitals getting "paid" to put people on the LCP
    Oh? £12.4 million paid to trusts who hit targets for LPC in the 2 to 3 yrs to 2012.
    ref: telegraph Nov1 2012,Bingham J.
    Hm. Sounds quite profitable to see them off?
    Sorry if its me being sceptical..

  • rate this

    Comment number 100.

    An uncle had advanced progressive neurological disease and did not want to eat or drink, He was semi-comatose. Choice:
    - Wire and plumb him up to machines to keep him going for a few weeks
    - Make him comfortable, keep his mouth damp and monitor him
    Which is the more humane? Hint: the Daily Mail has demonised the latter and my aunt who has cancer is now terrified she will be "forced to live".

  • rate this

    Comment number 99.

    Basically the fault lies within not teaching us about death. It is the most natural event as is birth. We need to accept death is the route we all take. In the words of Freddie - "who wants to live forever". I would not want to live unable to take part in life. Let us pray for a peaceful natural death.

  • rate this

    Comment number 98.

    81 Ricky. Playing God? We aren't all Beverley Allits or Harold Shipmans. Nor is it always about lack of communication, relatives are often too emotionally involved to understand what is actually being said at the time & only question afterwards.Full and proper explanations don't always help & can make things worse. Nurses and Docs have to take family abilities & comprehension into the equation

  • rate this

    Comment number 97.

    @77 Eddy: Wow! So you think doctors and nurses enjoy or are indifferent to their patients suffering?

    How twisted, cynical and irrational can human thinking sometimes be!

  • rate this

    Comment number 96.

    The problems arise when the relative is on the Liverpool care pathway, but asking for food and water, and staff ignore it
    Not everyone should be on the pathway, and it should be investigated for these kinds of failures, because the distress caused to families and patients is totally unacceptable

    If you think your relative shouldn't be on it, be ready to argue for them, you know them best!

  • rate this

    Comment number 95.

    Four weeks before Mum's death, a Doctor tried to convince me 'very forcefully' to start the LCP.
    I declined . Mum had two good weeks at home before the illness finally took it's toll.
    If swayed by this Doctor, we would have been denied this special time together.
    I raised this with the hospital but as the Doctor had left, nothing could be done.
    The medics don't always know best . Beware.


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